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ISSN: 2320-5407 Int. J. Adv. Res.

8(06), 327-335

Journal Homepage: -www.journalijar.com

Article DOI:10.21474/IJAR01/11102
DOI URL: http://dx.doi.org/10.21474/IJAR01/11102

RESEARCH ARTICLE

PREVALENCE OF PSYCHIATRIC MORBIDITIES AMONG WOMEN DURING POSTPARTUM


PERIOD IN BLOCK HAZRATBAL, DISTRICT SRINAGAR
Dr. Rachel Bashir1, Dr. Shahnaz Taing2, Dr. Zaid Wani3 and Dr. S. Mohammad Salim Khan4
1. PG Scholar, Department of Social and Preventive Medicine.
2. Prof. & Head, Department of Obstetrics and Gynaecology.
3. Associate Professor, Department of Psychiatry.
4. Prof. & Head, Department of Social and Preventive Medicine, Government Medical College, Srinagar.
……………………………………………………………………………………………………....
Manuscript Info Abstract
……………………. ………………………………………………………………
Manuscript History
Received: 05 April 2020
Final Accepted: 07 May 2020
Published: June 2020 Copy Right, IJAR, 2020,. All rights reserved.
……………………………………………………………………………………………………....
Introduction:-
Pregnant women and their families expect the postpartum period to be a happy time, characterized by the joyful
arrival of a new baby. Unfortunately, women in the postpartum period can be vulnerable to complications like
postpartum hemorrhage sepsis and psychiatric disorders1. Because of untreated postpartum psychiatric disorders can
have long-term and serious consequences for both the mother and her infant, screening for these disorders must be
considered part of standard postpartum care2. The terms puerperium or puerperal period or immediate postpartum
period are commonly used to refer to the first 6 weeks following childbirth3. Despite mounting evidence of
theimpact of maternal mental health on women and children, prevention, and treatment have been slow to enter into
maternal and child health (MCH) programs as rightly described as the neglected “m” in MCH programs4. The
WHO's mental health Gap Action Program has recently produced evidence based guidelines for the treatment of
depression in the primary health care setting in Low And Middle Income Countries, including in the context of
pregnancy and the postnatal period5. Despite the launch of India’s national mental health programme in 1982,
maternal mental health is still not a prominent component of the programme. Dedicated maternal mental health
services are largely deficient in health-care facilities, and health workers lack mental health training. The availability
of mental health specialists is limited or nonexistent in peripheral health-care facilities6. India is experiencing a
steady decline in maternal mortality, which means that the focus of care in the future will shift towards reducing
maternal morbidity, including mental health disorders7. In J&K the data on postpartum psychiatric disorders at
community level is limited and inconsistent. There the study is undertaken to assess the prevalence of psychiatric
morbidities among women during postopartum period.

There are mainly three types of postpartum psychiatric morbidities8,9:

Postpartum blues:
Present with self-limited mild and depressive symptoms such as mood labiality, anxiety insomnia, tearfulness,
during the first week after delivery and resolves spontaneously8,9. Prevalence rate is 30-75%. Its onset and duration
is usually in Hours to days. No treatment is required other than reassurance 8,9.

Corresponding Author:- Dr. Rachel Bashir


Address:- Postgraduate Scholar, Department of Social and Preventive Medicine, (Community Medicine), 327
Government Medical College, Srinagar.
ISSN: 2320-5407 Int. J. Adv. Res. 8(06), 327-335

Postpartum depression:
Is a common medical problem and is reported in 8-15% of women after delivery8,9. It has insidious onset in first 1-3
months after delivery depression symptoms are stronger and suicidal ideations are often seen. The problem of post
natal depression not only has immediate adverse effects but episodes of depression later on8,9. Postpartum
depression is characterized by tearfulness, despondency, emotional lability, feelings of guilt, loss of appetite, and
sleep disturbances as well as feelings of being inadequate and unable to cope with the infant, poor concentration and
memory, fatigue and irritability10. Some women may worry excessively about the baby’s health or feeding habits
and see themselves as, “bad”, inadequate, or unloving mothers10. Treatment is usually required8,9. In India,
prevalence rate is 23% in Goa (2002)11 and 11% in Tamil Nadu (2002)12. Postpartum depression (PPD) affects 10-
15% of all new mothers13.

Postpartum psychosis:
Has severe effects on mother, her new born child and family but can also lead to long term morbidity as the
condition can persist or may present with recurrent form of psychiatric illness seen in 2-4 weeks after delivery8,9. Its
presentation is often dramatic. It usually it usually presents with depressed mood, suicidal thoughts, delirium and
hallucinations and is reported in 1-2% of pregnancies. It is regarded as a psychiatric emergency. Its prevalence rate
is 0.1-0.2%.Its onset and duration is usually within weeks to months. Hospitalization is usually required 8,9.
Infanticide and suicide are observed in 4% and 5% of the women suffering from postpartum psychosis respectively.
Enquiring about suicidal and infanticidal thoughts is crucial during the assessment of women suffering from
postpartum psychosis14,15,16.

The risk factors associated with the development of postpartum disorders are: Primigravida; cesarean sections or
other perinatal or natal complication; family history of psychiatric illness, especially mother and sister having
postpartum disorder; lack of social support/unsupportive spouse, gender preference (male)17,18,19. In addition no
documented study has been done in this regard in Kashmir at community level to the best of our knowledge. This
study will also provide base line data to formulate policies and strategies for prevention and management of
postpartum psychiatric morbidity.

Objectives:-
1. To determine the prevalence of postpartum psychiatric morbidities in block Hazratbal.
2. To find out the determinants of postpartum psychiatric morbidities in block Hazratbal.

Materials and Methods:-


This was a cross-sectional, community based study conducted in Block Hazratbal, Jammu and Kashmir from 1st
April 2017 to 30th September 2018.

Inclusion criteria:
1. Women who are within their post-partum period (within 6 weeks of delivery).
2. Women who are residing in the study area during period of study.

Exclusion criteria:
1. Women who are diagnosed as psychiatric disorder before delivery.
2. Women who did not gave consent.

The sample size was calculated using the formula for single population proportion. As a result, a total of 422 women
were included based on the assumption of 95% confidence interval, margin of error 3%, anticipated proportion of
psychiatric morbidity in study population=10%, and a nonresponse rate of 10%.

For administrative convenience, the block has been divided into 4 health zones Hazratbal, Harwan, Nishat and
Tailbal and 12 sub centers, comprising of 16 health centers. These 16 health centres served as study areas. Total
antenatal registrations in block Hazratbal for year march 2016 to April 2017 were 1349 and ANC registrations per
month were 114 for that period. To achieve the required sample, consecutivesampling technique was used. From the
ANC registration records of subcentrethe women who were in the 4th week of postpartum period were visited at
their household with the help of an ASHA worker and were interviewed after taking the consent. We approached
422 women and only 400 gave consent for the interview.

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Post-partum psychiatric morbidities which include depression and post-partum psychosis in these women were
assessed using the MINI (International Neuropsychiatric Interview 2006 English Version 5.0.0 DSM-IV20 at 4
weeks after delivery. Postpartum blues were not assessed as they usually resolve spontaneously after first week of
delivery8,9. Study participants who were having depression were referred to psychiatry department of Government
Medical College Srinagar for management and treatment and their identity was kept confidential. The
socioeconomic status was obtained using Modified Kuppuswamy Scale 201721. This scale includes the education,
occupation of head of the family, and income per month from all sources.

The collected data was entered in Microsoft Excel spreadsheet and analysis was done using IBM SPSS V23.
Frequencies were obtained using descriptive statistics using appropriate statistical tools (IBM SPSS V23) for
analysis. Parametric tests were used for the data which followed normal distribution and non-parametric tests were
used for the data set which did not follow normal distribution. p value <0.05 was considered statistically significant.

Results:-
Among the subjects 12.5% belonged to the age group of 20- 25 years, 41% belonged to age group 26-30 years, 43%
belonged to age group 31-35 years and remaining 3.3% subjects were of 30-40years age group. Majority of the
subjects i.e. 39.75% were illiterate followed by 36.75% who were high school level and higher secondary level and
2.75% had acquired primary education,8.75% were of middle school level.12% of the study population were
graduate and postgraduate level. Among the study subjects 87% were unemployed and rest 13% were employed.
Majority of the subjects 52.5% belonged to nuclear family type and 47.5% belonged to joint family. Majority of
subjects 45% belonged to lower middle class followed by 43.25% belonged to upper middle class. 11% were of
upper lower class 0.25% were lower class and rest 0 .50% were upper class. Majority of the subjects were 98.75%
were married, 0.75% were divorced and widows were 0.5%. Majority of the subjects 33.25% were married for 6
years followed by 29.75% of subjects were married for 5 years, 15% of subjects were married for 4 years, 7.75% of
subjects were married for 7 years 6.75% were married for 3 years, 3.25% were married for 2years, 2.25% were
married for 8 years, 1.75% were married for 10 years and 0.25 % were married for 12 years. Majority of study
subjects 77.25% delivered by LSCS and 22.75% were delivered normally at full term.

Among the study participants 45.50% were para 2 and 43.50 were para 1 followed by 9.75% who were para 3 and
only 1.25% of women were para 4. Among the study subjects abortion was present in 11.75% and absent in 88.25%.
Among the study participants 51.50% mothers delivered female child and 48.50% delivered male child. Among the
babies, 1.25% died after birth and 98.75% were alive. Majority of babies i.e. 45.50% had birth order 2 followed by
43.50% babies had birth order 1 and 9.75% had birth order 3 and rest 1.25 %had birth order 4. Gender preference
(i.e. male child) was present in 52.25% of subjects and in rest 47.75% gender preference was absent. Marital conflict
was present in 5.75% of subjects and in rest 94.25 % marital conflict was absent. Social support was present in
92.50% of subjects and in 7.50% of subjects it was absent. Among the study subjects 0.75% were having family
history of psychiatric disorder and in rest 99.25% subjects family history of psychiatric disorder was absent.
Postpartum depression was present in 40 (10.00%) of subjects and in 360 (90.00%) of subjects it was absent.
Postpartum psychosis was absent in all 100%of the subjects. Out of 50 participants in the age group of 20-25 years,
4(8.0%) were having depression and 46(92.0%) were not having depression Out of 164 participants in the age group
of 26-30 years, 18 (11.0%) were having depression and 146 (89.0%) were not having depression Out of 173
participants in the age group of 31-35 years, 18 (10.4%) were having depression and 155 (89.6%) were not having
depression Among 13 participants in the age group of 36-40 years none was having depression. Out of the 159
illiterate participants, 17 (10.7%) were having depression and 143 (89.3%) were not having depression. Among the
11 study participants who were primary pass, 4 (36.4%) were having depression pass and 7 (63.6%) were not having
depression. Out of 35 subjects who were middle pass, 2 (5.7%) were having depression and 33 (94.3%) were not
having depression. Out of the 147 subjects who were matric pass 7 (4.8%) were having depression and 140 (95.2%)
were not having depression.

Among the 48 postgraduate/graduate subjects, 10 (20.8%) were having depression and 38 (79.2%) were not having
depression. The association between educational status and depression was statistically significant. Out of 348
unemployed participants 34 (9.8%) were having depression and 314 (90.2%) were not having depression. Among
the 46 employed participants 6 (11.5%) were having depression and 46 (88.5%) were not having depression. The
association between depression and employment status was not statistically significant. Among the 190 study
participants who lived in joint family 14 (7.4%) were having depression and 176 (92.6%) were not having
depression. Out of 210 study participants who lived in nuclear family, 26 (12.4%) were having depression and 184

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(87.6%) were not having depression. However the association between type of family and depression was not
statistically significant. Out of the 180 women who belonged to lower middle class 18 (10%) were having
depression and 162 (90%) women from lower middle class were not having depression. Out of 44 women who were
from upper lower class, 4 (9.1%) were having depression and 40 (90.9%) were not having depression. Among the
173 women who belonged to upper middle class 18 (10.4%) were having depression and 155 (89.6%) were not
having depression. However the association between depression and socioeconomic status was not statistically
significant. Out of 395 women who were married 38 (9.6%) were having depressionand 357 (90.4%) were not
having depression. Among the3 divorced mothers (recently divorced) 2 (66.7%) were having depression and 1
(33%) was not having depression. None was having depression among the widow mothers (recently widowed). The
association between the marital status and depression was statistically significant.

Out of 133 women who had been married for 6 years, 12 (9%) women were having depression and 121 (91%) were
not having depression. Among the 119 women who had been married for 5 years 15 (12.6%) were having
depression and 104 (87.4%) were not having depression. Out of the 60 women who had been married for 4 years 6
(10%) women were having depression and 54 (90%) were not having depression. Among the 31 women who had
been married for 7 years, 3 (9.7%) were having depression and 28 (90.7%) were not having depression. Among the
27 women who had been married for 3 years, 4 (14.8%) were having depression and 23(85.2%) were not having
depression. None was having depression among women who had been married for 2 years, 8 years, 10 years and 12
years. The association between depression and time since marriage was not statistically significant.Among the 174
women who were para1, depression was present in 19 (10.9%) and absent in 155 (89.1%). Among the 182 women
who were para 2, depression was present in 16 (8.8%) and absent in 166 (91.2%). Among the 39 women who were
para 3, depression was present in 5 (12.8%) and absent in 34 (87.2%). The association between depression and
parity was not statistically significant.Among the 91 women who had normal delivery 9 (9.9%) were having
depression and 82 (90.1%) were not having depression. Among the 309, women who delivered by LSCS, 31 (10%)
were having depression and 278 (90.0%) were not having depression. The association between mode of delivery and
depression was not statistically significant.Out of 353 women who did not have history of abortion 32 (9.1%) were
having depression and rest 321 (90.9%) were not having depression. Among the 47 women who had history of
abortion 8(17.0%) were having depression and 39 (83.0%) were not having depression. However the association
between depression and history of abortion was not statistically significant.

Out of the 194 women who were having male babies, 10 (5.2%) were having depression and 184 (94.8%) women
were not having depression. Among the 206 mothers who had female babies 30 (14.6%) were having depression and
176 (85.4%) were not having depression. The association between depression and sex of the baby was statistically
significant.Out of the 395 women who had live babies, 35 (8.9%) were having depression and 360 (91.1%) were not
having depression. Among the 5 women who had dead babies, all 5 (100%) were having depression. The
relationship between current baby status and depression was statistically significant.Among the 174 women who had
baby with birth order of one, 19 (10.9%) were having depression and 155 (89.1%) were not having depression.
Among the women who had birth order of two, 16 (8.8%) were havingdepression and 166 (91.2%) were not having
depression. Among 39 womenwho had baby with birth order of three, 5 were (12.8%) were having depression and
34 (87.2%) were not having depression. None was having depression among the women who had baby with birth
order of four. The association between birth order and depression was not statistically significant.Among the 191
women who did not have gender preference (male baby),9(4.7%)were having depression and 182(95.3%) were not
having depression.Among the 209 women who had gender preference for (male baby),31(14.8%) were having
depression and 178 (85.2%) were not having depression. The association between gender preference and depression
was also statistically significant.Among the 377 women who did not have marital conflict, 34 (9.0%) were having
depression and 343(91.0%) were not having depression. Among the23 women who had marital conflict 6(26.1%)
were having depression and 17(73.9%) were not having depression. The association of marital conflict with
depression was statistically significant.

None was having depression among the30 women who did not have social support and among those women who
had social support, depression was present in 40(10.8%) and absent in 330(89.2%). The association between social
support and depression was not statistically significant.Out of 397 women who had no family history of psychiatric
disorder, 38(9.6%)were having depression and 359 (90.4%) women were not having depression.Among the 3
women who had family history of psychiatric disorder,2(66.7%) were having depression and 1 (33.3%) were not
having depression.The association between family history of psychiatric disorder wasstatistically significant.

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Discussion:-
In our study out of 400 study subjects, depression was present in 40 (10%) of subjects and in 360 (90%) of subjects
it was absent. and thus the prevalence of depression among the women in the postpartum period was found to be
10%, which is similar to the findings in the studies by HamadamandTamim et al (2011)22in United Arab
Emirates(10%), Chandran M et al(2002)12 Tamil Nadu in India(11%).However Savarimuthu et al
2010(India)23reported 26.3% prevalence of postpartum depression, while in study conducted by Patel et al (2002)11in
Goa India, 23% of mothers were having depression.

Postpartum psychosis was not seen in any of the participants. This may be due to the fact that our study was
conducted in the community and postpartum psychosis is an acute emergency condition mostly seen in maternal and
child health institutions soon after delivery. Rachel Vander Kruik et al (2018)24, conducted a meta- analysis and
found that the prevalence of postpartum psychosis is 0.89-2.6 (per 1000) Harlow BL etal (2007)25reported that
approximately 90% of all postpartum psychotic episodes occurred within the first 4 weeks after delivery.

Majority of the subjects 43.25% subjects were from the age group of 30-36 years followed by 41.0% were from the
age group of 26-30 years while 12.5% belonged to age group of 20-25 years and only 3.3% were from age group of
35-40 years. The mean age of the study participants was 30 years (with a standard deviation of3.71), which
corresponds well with the usual childbearing age of females. The reason can be that Kashmiri females usually tend
to marry after 25 years which can account for high percentage of subjects 25 years and above. In a study done by
Affonso et al (2000)26, the mean age of the study participants was >25 years. Out of 50 participants in the age group
of 20-25 years,4(8.0%)were having depression and out of 164participants in the age group of 26-30 years, 18
(11.0%)were having depression. Out of 173 participants in the age group of31-35years, 18(10.4%) were having
depression and none was having depression in the age group of 36-40 years. Similar findings were reported by
Khairabadi et al (2009)27and Savarimuthu et al(2010)23, Prost A et al (2012)28.

Majority 39.75% were illiterate followed by 36.75% who were high school level and higher secondary level and
12% of the study population were graduate and postgraduate level, 8.75% were of middle school level and rest
2.75% had acquired primary education. The reason for low education is due to gender bias which is still prevalent in
our society and the sociocultural influences prevalent in the area and the socioeconomic scale of the parental
families. In a study conducted by Kheirabadi et al (2009)27in Iran majority of participants were illiterate. The Iranian
socio culture values are almost in accordance with those in Kashmir. Out of the159 illiterate participants, 17 (10.7%)
were having depression and among the 11 study participants who were primary pass, 4(36.4%) were having
depression.

Out of 35 subjects who were middle pass, 2(5.7%) were having depression. Out of the 147 subjects who were matric
pass 7(4.8%) were having depression and among the 48 postgraduate/graduate subjects, 10(20.8%) were having
depression. The association between educational status and depression was statistically significant. The high
percentage of depression in the illiterate mothers may be due to their low understanding of the entire natlaity process
and its sequale. The findings are similar to the study conducted by Khairabadi et al (2009)27,Veisani Y et al (2013)29,
Reck et al (2008)30. Among the literate mothers the cause may be due to the stress related to their working or
professional responsibilities and also trying to maintain normal personal and social norms.

Among the 400 study subjects, majority (87%) were unemployed and rest 13% were employed. It is not out of place
to mention that the femaleslabeled as unemployed in the study were performing routine normal householdchores and
may also be termed as homemakers. Majority of participantswerehomemakers. In studies conducted by Patel et al
(2002)11, Chandran et al(2002)12and Thanagaph et al (2005)31majority of participants werehomemakers. Out of 348
unemployed participants 34(9.8%) were havingdepression and among the 46 gainfully employed participants
6(11.5%) werehaving depression. The association between depression and employment statuswas not statistically
significant. Similar findings were reported by Hamadan and Tamim et al (2011)22and Khairabadi et al (2009)27.

Majority of the subjects 52.5% belonged to nuclear family type and rest47.5% belonged to joint family. This may be
due to modernization whereindividual and materialistic interests prevail over social values and nuclearfamily is
considered as a symbol of modernity while as joint family system isconsidered as old fashioned and young couples
don’t like to share the extendedresponsibilities. However, Kashmir being a Muslim dominated traditionalsociety and
people still respect the old culture of joint families which has nowbecome obsolete in modern society. Majority of
the participants were fromnuclear family in a study conducted by Thanagaph et al (2005)31. Among the190 study

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participants who lived in joint family 14(7.4%) were havingdepression. Out of 210 study participants who lived in
nuclear family,26(12.4%)were having depression. This again shows a trend that the motherswho had enjoyed the
joint family care during their pregnancy were better offthan the mothers who lived in the nuclear families. However
the associationbetween type of family and depression was not statistically significant.Thanagapha et al
(2005)31found that depression was more in nuclear familyas compared to joint family. However Shivalli S et al
(2014)32reported thatdepression was more in joint family system.

Majority of subjects45% belonged to lower middle class followed by 43.25% belonged to upper middle class,11%
were of upper lower class,0.25% werelower class and rest 0.50% were upper class. Out of the 180 women
whobelonged to lower middle class 18(10%) were having depression. Out of44women who were from upper lower
class, 4(9.1%) were having depressionAmong the 173 women who belonged to upper middle class 18 (10.4%)
werehaving depression. It means that middle class mothers were more stressed thanother socioeconomic groups.
However the association between depression andsocioeconomicstatus was not statistically significant. Gosh A
Gowswami et al (201l)33,Rahman et al 200434, El-Sayed et al (2013)35, Prost A et al 201228found that low
socioeconomic status is associated with depression. Nagpal et al (2008)36found that lower and middle
socioeconomic status was associatedwith depression. In in study conducted by Jane Fisher et al (2012)37 found thatin
middle and low income countries depression has strong association withsocioeconomic status.

Majority of study subjects 77.25% delivered by LSCS and 22.75% weredelivered normally at full term. The reason
for higher percentage of LSCS inour scenario might be that the study population is located within Srinagarmunicipal
limits which is the capital of J&K and has easy accessibility oftertiary care obstetric health services like tertiary
hospitals, district hospitalsand number of private nursing homes and another reason may be the personalchoice.
Probing into the mode of delivery and any possible association withdepression it was found that out of the 91
women who had normal vaginaldelivery 9 (9.9%)were having depression and out of the 309 women who
hadundergone Lower Segment Caesarean Section due to any reason,31(10%)were found to have postpartum
depression.The association between mode ofdelivery and depression was not statistically significant. Prost A et al
(2012)28reported that caesarean delivery is associated with postpartum depression in astudy conducted by
SoheilBaigi Sarah et al (2017)38in Iran they found thatemergency cesarean section was the main factor associated
with postpartumdepression.

Majority of the study participants i.e. 45.50%were para 2. This wasfollowed by 43.5%participants who were para1,
9.75% who were para 3 andonly 1.25% of women were para 4. Trying to associate mothers parity withpostpartum
depression it was found that out of the 174 women who were para 1,depression was present in 19 (10.9%) and out of
the 182 women who werepara2,depression was present in 16(8.8%) and out of the 39 women who
werepara3,depression was present in 5(12.8%).These results exhibit a classicpattern as the first pregnancy is usually
associated with a threat of unseen forthcoming events. However the association between postpartum depressionand
parity was not statistically significant. In a study conducted by MunkOslen et al (2014)39in Danish population in
which they found that highest riskof postpartum psychiatric disorder was found in those mothers who were paraone.
TalakeAzale et al (2018)40reported that multiparty is associated withpostpartum depression.

Among the study subjects history of abortion was present in 11.75% andabsent in 88.25%.This could be due to the
early registration and betterantenatal care. Out of 353 women who did not have history of abortion32(9.1%) were
having depression .Among the 47 women who had history ofabortion 8(17.0%) were having depression However
the association betweendepression and history of abortion was not statistically significant. Similarfindimgs were
reported by Thanagapah et al (2005)31however in contrast tothisStephanie A.M Giannandrea, MD, et al (2013) 41,
TalakeAzale et al (2018)40found that abortion and postpartum depression had strongassociation.

Majority of the babies 98.75% were alive and 1.25% of babies died afterbirth.The reason of the low perinatal
mortality rate is attributed to the fact thatin the recent decade the maternal and child health care delivery services
haveimproved by leaps and bounds and also the much specific programmesunderNational Health Mission,
(JananiShishuSurakshakaryakaram), JSSY (JananiShishuSurakshaYojna) are now being taken seariously by the
state. Enquiringabout the current baby status or birth outcome,it was found that out of 395mothers whose babies
were live and thriving, 35(8.9%) were havingpostpartum depression and among the 5 mothers whose babies died
after birth, all 5(100%) were having postpartum depression. The loss of a child during orafter birth is considered a
landmark event mentally, physically and socially forthe mother who suffered the loss. The death of baby is major
factor in makingthe mother prone to postpartum depression. The relationship between currentbaby status and

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depression was statistically significant. In a study conducted byProst A et al (2012)28, it was found death of the baby
was associated withdepression in the postpartum period. Kumar N et al (2016)42also reportedsimilar findings.

As per birth order of the off springs of the study subjects 45.50% hadbirth order 2 followed by 43.50% babies had
birth order 1and the rest werein the higher birth order. Among the174 women who had baby with birthorder of one,
19(10.9%) were having depression. Among the women who hadbirth order of two,16 (8.8%) were having
depression. Among 39 women whohad baby with birth order of three were 5(12.8%) were having depression
and34(87.2%) were not having depression. None was having depression among thewomen who had baby with birth
order of four. The association between birthorder and depression was not statistically significant. In a study
conducted byMunknOslen et al (2014)39in Danish population in which they found thathighest risk was found in
those mothers whose babies had birth order of one.

Among the study subjects majority (52.25%) had male genderpreference and in rest 47.75 % had no gender
preference and they had left theoutcome to their destiny.. Further analyzing the gender preference of the
studysubjects for male child it was found that out of the 191 women who did nothave gender preference (male
baby), 9(4.7%)were having depression. Amongthe 209 women who had gender preference for (male
baby),31(14.8%) werehavingdepression.This finding has a significant association many femaleswho
expected/wanted or their family wanted, male baby but delivered a femalechild further upsetting their hopes. The
reason could be female gender biasdue to which male gender is preferred over female in our society. Theassociation
between gender preference and depression was also statisticallysignificant.The findings in our study were similar to
the study conducted byPatel, 200211, M. Chandran et al. (2002)12. Upadhyay RP et al(2017)43,TelakeAzle et al
(2018)40.Howevever in a study by Sylvén SM et al (2011)44no significant difference in risk of PPD in relation to
baby gender could beshown 6 weeks and 6 months after delivery. However, women who gave birthto a male
offspring had a significantly higher risk of self-reported depressivesymptomatology 5 days after delivery.

In majority (94.25 %) marital conflict was not seen and 5.75% of thesubjects admitted having undergone some sort
of stress due to marital conflictduring the course of recent pregnancy. The reason for low percentage ofmarital
conflict could be that our culture and values promote harmony amongfamily and marital relationships due to which
the conflicts cannot find theirway in the relationships. Theassociation of marital conflict with depression was
statistically significant.Similar findings were reported similar findings were reported by O Hara andSwain (1996)13,
Beck (2001)45,Upadhyay RP et al (2017)43. Halim N et al(2017)46also reported that postpartum depression in middle
and low incomecountries is associated with marital conflict due to intimate partner violence.

Conclusion:-
As evident from our study postpartum psychiatric morbidities mainly depression is major problem in our community
so there is indication for routine screening of mothers in the postpartum period. In our study the main determinants
(risk factors) which had significant association with postpartum depression in mothers were female gender of the
born child, sex of the born child, current baby status, marital conflict, marital status, educational status and family
history of psychiatric disorder. Routine screening is also mandated to avoid, recognize and manage postpartum
psychiatric morbidity (depression), risk factors associated, and its consequence on mothers and their developing
children.

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